The Use of Remote Monitoring Technology Lisa Gibbs, MD Raciela B. Austin, MSN, NP-C University of California, Irvine SeniorHealth Center October 16, 2014.

The Use of Remote Monitoring Technology

Lisa Gibbs, MDRaciela B. Austin, MSN, NP-C

University of California, Irvine SeniorHealth Center

October 16, 2014

THE USE OF REMOTE MONITORING TECHNOLOGY

UNIVERSITY OF CALIFORNIA, IRVINE SENIORHEALTH CENTER

LISA GIBBS, MDRACIELA B. AUSTIN, MSN, NP-C

Innovations in the Healthcare of Older

Patients

Innovations in the Healthcare of Older Patients

Objectives:1) Understand how to implement iPAD

and Telemedicine remote monitoring programs.

2) List 2 potential barriers in the implementation of remote monitoring programs.

3) List 4 benefits of delivering healthcare via remote monitoring for older patients.

4) List 4 potential disadvantages of delivering healthcare via remote monitoring for older patients.


Patient Home Monitoring (iPAD)

Overall Objectives:

1) Reduce ER/Inpatient Admissions2) Improve Patient Satisfaction3) Improve Access to Care


Goals of iPAD Home Monitoring

1. Improve access to care through a nurse-based virtual visit

2. Improve transitions in care: Hospital to home

3. Reduce readmissions/ER visits


Review of literature (Last 5 years)

Methodology: telephone based and videoconference,

Measures: daily biometrics and symptom reporting

Mostly intended for chronic conditions (HF, diabetes)

Mixed Outcomes: reduction in hospitalizations and ED visits; increased mortality with telemonitoring


UC Irvine Pilot (January 2013 to March 2013)

1) Identify Eligible Patients Based on Set Criteria2) Develop new consent form3) Utilized iPAD minis to conduct videoconferencing


Eligibility Requirements:

1) One to two hospital admissions within the last 12 months

2) One to two emergency room visits within the last 6 months


Methods:

1) Videoconference – iPAD “face time” within 24-28 hours upon discharge from the hospital

2) Subsequent frequency of visits determined by clinician (30 days)

3) Re-enrolled in patient home monitoring if clinically indicated (after 30 days )


Exclusion Criteria:

1) Discharge to Skilled Nursing Home 2) Discharge to Assisted Living Facility3) Cognitive Impairment without English

speaking caregiver4) Non English/Filipino speaking patients


Geriatric Assessment

- Functional Abilities - Review of Medications (Correlate with

Diagnoses)- Home Environment- Address Questions/Concerns

Innovations

Demonstration


Case DiscussionMr. X

77 year-old Filipino maleMultiple Inpatient AdmissionsDiagnoses: Diastolic HF, HTN, AF,

Hx of Lung CA, Dyslipidemia, COPD, Cholecystitis

Living Condition Caregiver issues

Innovations in the Healthcare of Older Adult

Outcomes:

Mr. XEnrolled in iPAD x 30 days-Home Health Care Coordination -No inpatient admission/ER visits

Hospital Admission- Hypotension

RE-enrolled x 30days (2nd time)-Established PCP/Specialist -Home Health follow up


Case DiscussionMrs. Y

81 year-old Filipino femaleER/Inpatient Admission- HF and UTIDiagnoses: CAD, Diabetes, HTN,

Hyperlipidemia, AF, CHFLiving Condition: Caregiver 24/7


Outcomes:

Enrolled 30 days for iPAD Home Monitoring- 2 iPAD encounters- ER to Inpatient to Rehabilitation

Renewal of 30 days iPAD Home Monitoring- caregiver issues- moved out of state-patient deceased


Values/Benefits

Ease of Access to ProvidersEnhanced Coordination of Care Potential decrease in inpatient admissions

and Potential reduction in ER visits


Patient Comments:

“ peace of mind knowing that someone will call”“ great program I wish we can be on iPAD monitoring longer than 30 days.”“ great for my dad, he likes talking with you on the iPAD.”


Barriers in Home Monitoring using iPAD:

Poor Connectivity Missed Appointments Caregiver Issues


TelemedicineObjective:Coordination of care among seniors in

nursing homes; both sub-acute and custodial patients are eligible.

Purpose: The creation of a team-based telemedicine program will provide increased access to

primary care services among seniors at SNFs.


Review of Literature: 1) Rehabilitation/Stroke Patients2) Mental Health Patients3) SNF – autonomous robots to

assist nursing home staff (Finland)

4) SNF – telemedicine-based Parkinson's disease program to increase patient access to a neurologist (Pennsylvania)


Eligibility Requirements

1) UCI patients- Develop consent form

2) Consultations: non emergent issues- new onset cough, falls, new skin lesion/rash, abdominal pain, altered mental status, pain, weight loss


UC Irvine Pilot

Established Connectivity with 2 Orange County Nursing Home Facilities

Training – UCI Staff and Nursing Home Staff

“Live Consultations” (March 2013-Present)- one time videoconference- follow up determined by provider: “in-person” or

“telemedicine”


UCI Telemedicine


Telemedicine

Barriers to Implementation1) Cost

2) Staff training –asynchronous versus synchronous

3) Information Technology


Telemedicine

Benefits

1) Easy access to geriatricians-continuity of care

2) May potentially decrease costly transfer to emergency rooms/hospitals


QUESTIONS??

The Use of Remote Monitoring Technology Lisa Gibbs, MD Raciela B. Austin, MSN, NP-C University of California, Irvine SeniorHealth Center October 16, 2014.

Documents

days slide

eligible patients

telemonitoring slide

videoconferencing slide

npc innovations

ipad x

hospital admissions

skilled nursing home